Individual
DR. BOONLUA RATANAWONGSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2223 W STATE ST, SUITE 107, OLEAN, NY 14760-1938
(716) 373-0444
(716) 373-5031
Mailing address
2223 W STATE ST, SUITE 107, OLEAN, NY 14760-1938
(716) 373-0444
(716) 373-5031
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
118639-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00590010
—
NY
Enumeration date
11/08/2006
Last updated
03/04/2008
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